Imaging recommendation · Abdomen · Pelvis

Living renal donor — pre-operative imaging

Q: What's the alternative imaging for living renal donor — pre-operative imaging when differential renal function not equal?

NM — Tc-99m MAG3 or DTPA renogram (iv contrast).

Q: What's the alternative imaging for living renal donor — pre-operative imaging when ct contrast contraindicated?

MRI — MR angiography of renal arteries + MR urography (iv contrast).

Q: What's the alternative imaging for living renal donor — pre-operative imaging when suspected stone disease — quantification?

CT — Non-contrast CT with stone protocol (no contrast).

Recommended: CT angiography of the kidneys (renal donor protocol) is the preferred imaging study for living renal donor — pre-operative imaging. Multiphase CT: non-contrast (stones) + arterial (renal artery anatomy + accessory arteries) + nephrographic/portal venous (parenchyma + venous anatomy) + delayed/excretory (collecting system anatomy).

Recommended study

CT angiography of the kidneys (renal donor protocol)

CT IV contrast Preferred Abdomen · Pelvis Outpatient Reviewed 2026-05

Multiphase CT: non-contrast (stones) + arterial (renal artery anatomy + accessory arteries) + nephrographic/portal venous (parenchyma + venous anatomy) + delayed/excretory (collecting system anatomy). Document number and origin of renal arteries and veins, presence of accessory arteries, retroaortic / circumaortic veins, and any ureteral / collecting system anomaly. Differential renal function may need adjunct nuclear medicine.

If the default doesn't apply

Differential renal function not equal

NM Tc-99m MAG3 or DTPA renogram IV contrast

CT contrast contraindicated

MRI MR angiography of renal arteries + MR urography IV contrast

Suspected stone disease — quantification

CT Non-contrast CT with stone protocol No contrast

Watch-outs

Accessory renal arteries

Present in ~30% of donors — missing one means an ischemic graft. Report all vessels with origin, course, and parenchymal territory.

Retroaortic / circumaortic left renal vein

Surgical implication — affects clamping and division. Report explicitly.

Unsuspected incidentalomas

Adrenal nodules, complex cysts, renal masses — these can disqualify a donor. Characterize fully before donation.

Pearls

Right kidney is typically donated when arteries are equal — shorter renal vein on the left means surgical preference for the left kidney in the recipient bed.
Report lengths: longest parenchymal dimension, renal vein length to IVC, renal artery length to aorta.
Excretory phase identifies duplicated collecting systems and ureteral anatomy.